CMS Holds Webinar Entitled, "Establishing Appeal Rights for Applicable Plans"

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Here's What Defendants Should Know...

July 7, 2015

On May 5, 2015, the Centers for Medicare & Medicaid Services (CMS) held a webinar entitled "Establishing Appeal Rights for Applicable Plans, Including Liability Insurance (Including Self-Insurance), No-Fault Insurance, and Workers’ Compensation Laws or Plans." This webinar built on the April 22, 2015 Memorandum CMS Issued entitled "Appeal Rights for Applicable Plans." In these two offerings, CMS provided carriers of liability insurance (including self-insurance), no fault-insurance and workers’ compensation with an overview of the formal appeals process established by the SMART Act as issued in CMS’s Final Rule on February 27, 2015. [Both the Final Rule and the PowerPoint are available as links from DRI’s Medicare Secondary Payer Task Force webpage.]

For an entity to take advantage of CMS’ Appeal Rights, it must be an Applicable Plan. An Applicable Plan is defined as being: liability insurance (including self-insurance), no-fault insurance, or workers’ compensation law or plan. See 42 USC §1395y(b)(8) and 42 CFR 405.902. This Memo provides information on the Appeals process, first with an overview and then with more detailed considerations.

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